Patent Application
20050216084
The subject invention relates to a collapsible, rotatable and tiltable spinal hydraulic prosthesis device and system for implantation of an individualized spinal disc prosthesis assembly to replace a degenerated disc in an intervertebral level of the spine. In particular, the present invention directs itself to a modular spinal prosthesis assembly formed of selectable components, the components allowing optimal individualization of the spinal disc prosthesis for a particular patient. Furthermore, the present invention is directed to a spinal disc prosthesis comprising a bio-compatible metallic bellows formed from a plurality of rigid washer-like members to minimize shear and lateral movements, filled with a non-compressible fluid and a compressible fluid, and permitting compression and tilting movements. Additionally, the bellows contain other axial load dampening mechanisms, including a dash pot mechanism and at least one biasing member.
More particularly, the invention directs itself to a modular spinal prosthesis assembly comprising a pair of opposing selectable crown plates having a selectable bellows cartridge interposed, with the assembly permitting rotation of the two vertebrae adjacent to the prosthesis relative to each other.
The invention further directs itself to an implantable modular spinal prosthetic device having selectable cross-sectional profiles, selectable angles of lordosis, and selectable load-bearing capacities. By the appropriate selection of modular components, the collapsible, rotatable and tiltable spinal hydraulic prosthetic device assembly implanted in a particular patient at a particular spinal level is optimized.
Implantable spinal prosthetic devices are well known in the art. Presently, the primary method used to remediate severe disc disease, spinal instability, discogenic pain, and/or spinal stenosis, is by surgical spinal fusion. In the spinal fusion procedure, two or more adjacent vertebrae are displaced, the spinal discs in between the vertebrae are removed by dissection, and crushed bone material is inserted between the two vertebrae; the bony material promotes the growth of new bone in the intervertebral space. The bony fusion material may be harvested intra-operatively from the patient's iliac crest or, alternatively, banked bone may be used. Since the fusion depends upon the ingrowth of new bone which takes months, mechanical means are necessarily incorporated at the time of surgery to maintain the stability and proper spacing between the vertebrae so as to permit the patient to carry normal loads imposed on the patient's spine during normal activities. Once the affected vertebrae are fused, that spinal segment will no longer take part in normal flexing, extending and twisting movements; higher stress loads will subsequently be imposed on discs and vertebra above and below the fused vertebral segment, often leading to the patient developing transition syndrome.
An important goal of spinal disc prosthesis implantations is to obviate the loss of normal biomechanics and range of motion associated with surgical fusion of a diseased spinal segment. Lordosis is an important element of the biomechanics of the spine, especially in the lumbar spine. While the lumbar vertebrae could be articulated in such a way that they form a straight vertebral column, this is not the shape assumed by the normal lumbar spine when a person is in the upright posture. This is because the sacrum, on which the lumbar spine rests, tilts forward so that its upper surface is inclined downwards and forwards. The size of this angle, with respect to a horizontal plane of the body, has a value in the range of about 40-45 degrees and increases by about 8 degrees upon standing. A straight lumbar spine would have to be inclined forward to articulate with the sacrum. In order to restore a normal upward orientation and to compensate for the normal inclination of the sacrum, the intact lumbar spine must assume a curve that is known as the lumbar lordosis. The shape of lumbar lordosis is achieved as a result of several factors. One of the main factors is the shape of the lumbar discs, and particularly the L5-S1 lumbosacral intervertebral disc. The L5-S1 lumbosacral disc, more than other lumbar intervertebral discs, is substantially wedge-shaped. Typically, the posterior disc height is about 6 or 7 mm less than its anterior height. The angle formed between the bottom of the L5 vertebrae and the top of the sacrum (S1) is found to vary from person to person in a range of roughly 5 to 30 degrees, with an average value of about 16 degrees.
One important advantage that derives from the lumbar lordosis is resilience to compressive forces and shocks. In a straight lumbar spine, axial compressive forces would be transmitted through the vertebral bodies and intervertebral discs and the only mechanism to protect the lumbar vertebra would be the shock-absorbing capacity of the intervertebral discs.
In a normally curved lumbar spine, compressive forces are transmitted through the posterior ends of the intervertebral discs while the anterior ends of the vertebral bodies tend to separate. Compression tends to accentuate the lumbar lordosis, which tendency tenses the anterior ligaments, which in turn resists the accentuation. Thus some of the energy of the axial compressive force is diverted into the stretching of the associated ligaments instead of being transmitted directly to the next vertebral body. In order to restore relatively normal biomechanical relationships to the vertebral column having structural derangements severe enough to require prosthetic spinal disc implantation, the prosthesis ought to provide for and replicate—as much as possible—the normal lordosis found in the healthy spine.
Axial compression is the movement that occurs during weight-bearing in the upright posture, or as a result of contraction of the longitudinal back muscles. During compression, intervertebral discs undergo an initial period of rapid creep, deforming about 1.5 mm in the first 2 to 10 minutes depending on the size of the applied axial load. Subsequently, a much slower but definite creep continues at about 1 mm/hour. Depending on age, a plateau is attained by about 90 minutes beyond which no further creep occurs. It is therefore important to incorporate this gradual accommodating compression—this cushioning—of the intervertebral disc to axial loads as part of the effort to restore and replicate normal vertebral biomechanics as much as possible.
During the axial rotation of an intervertebral joint inherent in twisting movements, the normal intervertebral disc resists torsion more than bending. Normally, the stress-strain curves for torsion rise steeply in the range of 0 to 3 degrees of rotation; beyond 3 degrees very large forces have to be applied to rotate the disc further. The risk of disc element failure increases substantially as the amount of rotation approaches 12 degrees, suggesting that 12 degrees is normally the maximal range of rotation. Thus, in order to replicate normal spine movements, an implanted prosthetic spinal disc ought to permit at least 3 degrees of rotation and preferably between 8 and 12 degrees of maximal rotation. None of the currently available disc prostheses provide for anything close to this amount of rotation.
Commonly used implantable spinal prosthetic devices include semi-rigid elastomeric filler materials that are sandwiched between two layers of some bio-compatible metal. The upper and lower plate surfaces typically have multiple spikes for their fixation to the vertebral end plates. Other similar devices offer means to screw the upper and lower plates to the co-joining vertebrae and some also include plates treated to promote bone growth into them. A few of the newer devices permit a small amount of articulation between the vertebrae but the extent of flexing and twisting is quite limited; furthermore, the elastomeric materials and their bonding agents in these devices have a disappointingly limited longevity. Ideally, a spinal disc prosthesis should last 30 to 40 years and be able to withstand approximately two million compression cycles per year.
It is a purpose of this subject invention to provide an implantable spinal disc prosthesis assembly comprising a combination of selectable modular components that has a long life expectancy, a negligible rate of failure and/or complications, and provides for maximal articulation in all normal physiological planes of movement within the spine. More particularly, the subject spinal disc prosthesis allows for tilting from side-to-side, rotation such as with twisting movements, and compression along a primary axial direction to absorb and transmit axial loads typical for normal activities.
Among the prior art spinal prosthesis is the device in U.S. Pat. No. 5,002,576. The patent reference is directed to an intervertebral disc prosthesis. This reference teaches a prosthetic disc device provided with a central elastomeric layer sandwiched between two cover plates. This particular prosthetic disc device offers neither rotation between the vertebra nor does it provide for any significant amount of bending in the forward, backward, or side directions.
Another prior art prosthetic disc implant is shown in U.S. Pat. No. 4,932,975. This reference patent is directed to a vertebral prosthesis. The prosthetic device disclosed in this patent includes a flexible bellows but the bellows here do not allow for rotation between the two adjacent vertebrae.
U.S. Pat. No. 3,875,595 discloses and claims intervertebral disc prosthesis along with instruments for positioning the same. The prosthesis is a hollow, bladder-like member with an expanded shape having the appearance of a natural nucleus of a normal spinal disc. The device does not provide for rotation between adjacent vertebrae, thus failing to provide the patient will full articulated movement.
U.S. Pat. No. 5,571,189 is directed to an expandable fabric implant for stabilizing a spinal motion segment. The implant is in the form of an inflatable bag positioned within a cavity artificially formed intervertebrally within the spine. The inflatable bag does not allow for rotation of that spinal motion segment.
Yet another prior art prosthesis is disclosed in U.S. Pat. No. 5,755,807. This patent is directed to an implant module unit and rotating seal for a prosthetic joint. The implant includes a ball-and-socket joint surrounded by a flexible metallic bellows. The system has certain limitations, namely, that it is subject to wear and premature failure as a result of friction and the buildup of particle debris.
U.S. Pat. No. 5,401,269 discloses an intervertebral disc prosthesis, the Charité disc prosthesis. This prosthesis does allow some minimal rotational movement, as well as a small amount of tilting and bending movement, by providing for an articular surface with surface forms curved with different average radii in the median section and the frontal section. Unlike the present invention, the Charité prosthesis does not provide for axial compression. In addition, the Charité prosthesis allows for some translational movements, which while mimicking normal physiological movements to some extent may not be well tolerated in the context of the multi-level spine degeneration typical of patients requiring such prosthetic implants. Furthermore, the components of the Charité prosthesis do not allow for individualization of the device's axial load-bearing capability; in contradistinction to the present invention, Charité prostheses offer negligible shock absorption and seems to permit progression of the Transition Syndrome whereby spinal levels above and below the implanted level suffer progressive disc and joint degeneration.
The present subject application device provides for improvements to the rotatable, compressible and tilting functions of the parent application device. The crown plate members as disclosed and claimed herein inventively provide for both selectable lordosis angles and selectable cross-sectional profiles. The selectable rotatable, compressible and tiltable cartridges have pre-loaded bellows that extend the device's functional lifetime indefinitely. The cartridges also provide enhanced axial load-bearing and shear-resisting capabilities as a result of the axial load bearing mechanism comprised of biasing members—a dashpot and springs in the preferred embodiment—positioned within the cartridge's bellows assembly. The selectable modular components of the present spinal disc prosthesis assembly permit optimization of the disc prosthesis assembly on a patient-by-patient basis.
The prior art does not include a combination of elements forming a modular collapsible, rotatable and tiltable spinal hydraulic prosthesis assembly that is optimizable on a patient-by-patient basis. The present invention solves the problematic unavailability in the prior art of individually optimizable spinal disc prostheses by providing for crown plates selectable according to a best cross-sectional profile and lordosis angle, where selected crown plates are best for a particular patient's needs; and for selectable cartridges with pre-loaded metallic bellows having redundant biasing elements to augment axial load-bearing and shear-resistance. The selectability of a spinal prosthesis components—as provided by the present invention—according to selectable lordosis angles, selectable crown plate shapes and sizes, and selectable load-bearing capabilities, permits optimization of the spinal disc implant assembly that is tailored to an individual patient. Optimization is accomplished by selecting the specific disc prosthesis components according to important relevant factors that may include the particular patient's gender, age and body habitus, the extent of co-existing spinal degeneration at nearby spinal levels, the patient's level of activity and general condition, as well as the particular spinal level(s) in need of prosthetic spinal disc replacement.
The present invention provides for a collapsible, rotatable, and tiltable hydraulic spinal disc prosthesis system with selectable modular components. The system comprises an individually optimizable compressible, rotatable, and tiltable hydraulic spinal disc prosthesis assembly for the surgical replacement of a severely diseased or missing intervertebral disc, as well as at least one insertion instrument to facilitate the surgical implantation of this hydraulic disc prosthesis assembly.
The present modular hydraulic spinal disc prosthesis assembly further provides for selectable crown plate modules that sandwich between them at least one selectable compressible, rotatable and tiltable hydraulic disc prosthesis cartridge, the crown plates being affixed to the corresponding opposed vertebral end plates.
The selectable cartridge interposed between the crown plate modules is comprised of pre-loaded flexible bellows preferably capped at the cephalad end of the bellows by a center bearings plate, and at the caudal end by an endcap having formed therein a sealable fluid conduit to facilitate filling and pressurizing the bellows and dashpot chambers with a mixture of compressible and non-compressible fluids.
The rotational elements are preferentially ceramic components slidingly juxtaposed and lubricated by water or the like, thereby providing for substantially normal articulated rotational movement at that spinal motion segment. The cartridge bellows assembly is hermetically sealed at the ends to provide a fluid-tight chamber containing an axial load-bearing mechanism. The axial loads are absorbed, transmitted and dispersed by a combination of a dash pot located centrally in the bellows assembly, and at least one biasing member such as a coil spring in close proximity to the dashpot to augment the axial load bearing capability provided by the bellows assembly and the dashpot. The selectable nature of the spring and load bearing elements allows the optimal choice among selectable cartridges to best accommodate anticipated demands as presented by particular clinical situations. Furthermore, the dashpot piston is provided with a spherical ball bearing—preferably made of a ceramic material or the like—through which the piston extends, which ball bearing is constrained by a shear-resisting retainer ring seated within the bellows assembly.
Additionally, the lifespan of the bellows element, which is subjected to repeated axial loading and unloading under a spectrum of tilting and bending movements, is extended indefinitely by preloading the bellows to a sub-atmospheric pressure as described herein.
It is a principle objective of the subject invention to provide a hydraulic spinal prosthesis for replacement of a missing or diseased intervertebral spinal disc and annulus.
It is a further objective of the subject hydraulic spinal prosthetic device to provide a hydraulic spinal prosthesis with dimensions and load-bearing capabilities that can be optimized for individual patients.
It is yet a further objective of the subject hydraulic spinal prosthesis device to provide a spinal disc replacement that permits substantially physiologic range of motion—including rotation—between the vertebrae adjacent to the implanted prosthesis.
It is also an objective of the subject inventive concept to provide a hydraulic spinal prosthetic device that resists translation and shear movements in the horizontal, coronal and sagittal planes.
It is also an important objective of the present invention to provide a hydraulic spinal prosthetic device provided with a selectable cartridge having a set of bellows filled with a mixture of compressible and incompressible fluids and preloaded to a sub-atmospheric pressure so as to very substantially prolong the functional lifespan of the implanted hydraulic spinal disc prosthesis.
It is yet another objective of the present invention to provide a hydraulic spinal prosthetic device having selectable load bearing capability afforded through the bellows, the dash pot mechanism, as well as by at least one further biasing member, such as coil spring(s).
It is a further important objective of the present invention to provide a hydraulic spinal prosthesis with fluid-filled bellows that have a washer-convoluted design, and which permits a substantially physiologic range of movements.
An important objective of the present inventive device is to provide a prosthetic hydraulic spinal disc replacement that reduces the incidence of Transition Syndrome.
The present inventive device takes as an important objective to provide a hydraulic prosthetic spinal disc replacement that does not migrate from its initial implantation position.
It is an important objective of the present inventive device to provide a hydraulic prosthetic spinal disc replacement that improves the patient's spinal stability at the affected motion segment as well as at nearby spinal levels.
It is a further objective of the present invention to provide a modular hydraulic spinal prosthesis device and corresponding insertion instrument(s) that does not demand unusual or extraordinary surgical skills to implant an individually-optimized spinal prosthesis assembly properly. The terms “insertion instrument” and “insertion tool” are used interchangeably and synonymously throughout the disclosure.
Referring now to the figures, there is shown a collapsible, rotatable, and tiltable hydraulic spinal disc prosthesis system with selectable modular components. Prosthetic modular assembly 1 includes an opposed pair of crown plate members 10A, B and a spinal disc prosthesis cartridge 100 sandwiched between the crown plates 10A, B. The bellows cartridge 100 is comprised of a cephalad end cap member 20, a caudal end cap member 20′, and an assembly of collapsible and tiltable bellows assembly 50 between them.
The bellows cartridge 100 is rotatably coupled at the cephalad end to the cephalad end cap member 20 by at least two sets of ball-bearings 31, 32. The first rotatable coupling is a radial thrust bearing assembly 28 comprising a first race 36 and ball bearings 35 and positioned to resist shearing forces. Axial rotation is further supported by a second bearing assembly with a plurality of ball-bearings 32 maintained in regular spacing in a respective race by a bearing retainer seal member 30 interposed between the cephalad end cap member 20 and the center bearings plate 40. The second race, in which the ball-bearings 32 travel, is formed at its the top and bottom by a pair of opposed annular recesses defined in the opposing surfaces of the cephalad end cap member 20 and the center bearings plate 40, and laterally by the arcuate edges formed in the retainer seal 30. The second bearing assembly is positioned to rotationally transmit axial loads placed on the system. The two races are offset longitudinally relative to each other, adding to the system's stability and resistance to shearing forces.
The caudal end, or synonymously, inferior endcap of the bellows assembly 100 is fixedly attached to the caudal crown plate assembly 10′. The caudal end cap member 20′ has formed therethrough a fluid channel 25 in fluidic communication with the fluid-filled bellows chamber 52 by means of aperture 27, and in further fluid communication with the dashpot chamber 70 by means of opening 29. Seen within the bellows assembly 50 is the dashpot mechanism comprising a piston 45 formed from the center bearings plate 40 as a cylindrical protrusion received into the dashpot chamber recess 71 which is defined by extensions of the caudal end cap member 20′ at the other end to the cephalad end cap member and a retaining ring 44 defining the cephalad limit of the dashpot chamber 70.
Fixedly juxtaposed onto those end cap extensions, the retaining ring 76 in the preferred embodiment assumes the shape of a cored sphere with a substantial flattening of the opposing poles of the sphere and a defining a cylindrical shape for its inner surface. The retaining ring 76 is fixedly juxtaposed with the dashpot piston 45, and likewise, the dashpot piston 45 is fixedly mounted through the bearing 74, so that the dashpot piston 45, the bearing 74, and the retaining ring 76 are all coaxial with the bellows assembly 50. At least one biasing mechanism 80 is incorporated within the bellows assembly 50 and, in a preferred embodiment, is coil spring 80 positioned within recess 73 formed centrally within the dashpot piston 45. In the preferred embodiment illustrated in
Referring to
The selectable lordosis angle refers to the angle formed between the vertebral engaging surface of the crown plate top 10A and the bottom surface of crown plate 10B fixedly connected to the cephalad end cap 20 of cartridge assembly 100. The selectable crown plates 10, 10′ have a cross sectional profile that may be further chosen so as to best match in size and shape the patient's vertebral end plate to which the disc prosthesis assembly 1 is to be fixedly attached.
On the vertebral engaging surfaces of the crown plates 10 and 10′ there are a plurality of spikes 12, 12′ respectively, formed and protruding from the vertebral engaging crown plate surfaces at the periphery, and designed to secure the disc prosthesis assembly 1in position between the adjacent vertebrae. In the preferred embodiment each vertebral engaging crown plate surface has six spikes 12 but the number of such spikes are preferably in the range of two to eight spikes. Further apparent from
Further evident in the Figures are the paired opposing pawl recesses 91, 91′ formed in the anterior aspect of opposed inner surfaces of crown plates 10A and 10′A and adapted to receive therein a securing element or pawl 310 of insertion instrument 300 for purposes of intra-operative device placement. As may be further appreciated from the perspective views of the prosthesis assembly 1, a through channel 14 is formed in the vertebral engaging surface of crown plate members 10 and 10′, in between 10A and 10′A, and 10A′ and 10′A′ respectively. The through channels 14 are centrally located, extend between the anterior and posterior edges of the crown plate members 10 and 10′ and, in the preferred embodiment, have a chined or beveled cross-sectional profile. The through channels 14 are important for the proper stereotactic positioning of the prosthetic device 1 during surgical implantation.
Additionally, the vertebral engaging surfaces of the crown plates 10, 10′ are formed with a roughened irregular surface, having a scintered or otherwise textured surface so as to facilitate the permanent fixation of the prosthetic assembly 100 subsequent to surgical placement and implantation. The cross-sectional profile of the through channels 14 matingly complement the distraction bars 320 of insertion instrument 300 as seen in
The disc prosthesis cartridge assembly 100 is comprised of a compressible and tiltable bellows assembly 50 that, together with center bearings plate 40 and caudal end cap 40′ which cover the top and bottom bellows openings, define a bellows chamber 52. In the preferred embodiment, the bellows assembly 50 is made from a plurality of Bellevile washers each joined to the adjacent washers by welding or other permanent joining at the edges; the bellows assembly 50 is preferably comprised of titanium but other like materials are also contemplated. Bellows chamber 52 is filled with a mixture of compressible and non-compressible fluids and fluidically communicates with the dash pot chamber 70, 73 by fluid conduits 63, 65, and 67 as illustrated in
The 360° rotation afforded by the disc prosthesis 1 is provided structurally by a bearing retainer ring 30 formed with regularly-spaced through-holes to accept a plurality of ball-bearings 32 rollably positioned between center bearings plate 40 and cephalad end cap 20. The ball-bearings 32 slide around in the race defined by the partly circular channels formed on opposing surfaces of center bearings plate 40 and end cap 20 respectively, with the bearing retainer seal member 30 maintaining the ball-bearings 32 in a preferred spacing. As may be seen in
Additionally, a radial thrust bearing assembly 28 is centrally placed in the device 1 and comprises a caudal cylindrical protrusion 25 formed from and extending down from cephalad end cap 20; inner and outer encircling race members 36A,B; and a plurality of ball bearings 35 rotatably seated in the race formed by the opposing inner and outer race members 36A,B respectively. This axially formed caudal cylindrical protrusion 25 is received in a cephalad recess of the center bearings plate 40 and is positioned coaxial with the axis of rotation of the disc prosthesis 1. Inner encircling race member 36A is fixedly coupled with the caudal cylindrical protrusion 25 of end cap 20, and outer encircling race member 36B is fixedly positioned within the centrally positioned cephalad recess of center bearings plate 40.
The dashpot mechanism is coaxial with and centrally positioned within the bellows assembly 50 and comprises a central axial dashpot piston 45 formed from the caudal surface of the center bearings plate 40, which dashpot piston 45 has formed within it a fluid-filled recess 73 that is a fluidic extension of dashpot recess 70. The dashpot piston 45 is press fitted in and through the central axial bore of spherical bearing 74; preferably, spherical bearing 74 is formed with the shape of a cored sphere having a flattened top and bottom. The substantially spherical lateral sides are in sliding juxtaposition with the dashpot walls. In the preferred embodiment both the spherical bearing 74 and the retaining ring 76 are composed of the ceramic material Silicone Nitride for which water or similar aqueous solutions are an excellent lubricant. The use of other similar ceramics such as Al2O3, or like materials, for the spherical bearing 74 as well as ball bearings 32, 35, is within the contemplation and scope of the subject inventive concept.
At least one biasing member, which in the preferred embodiment is a coil spring member 80, is coaxially mounted within and/or around dashpot piston 45 as seen in
The caudal end cap 60 has formed within it a fluid channel 65 that fluidly connects the dashpot chamber 70, the bellows chamber 52 and an external aperture 67 adapted to receive a sealing plug or screw 60 that creates a watertight closed chamber 65, 70, 73 when in place. The dashpot chamber 70 communicates with the fluid channel 65 by means of aperture 63; the bellows chamber 52 is in fluidic communication with the fluid channel 65 by means of opening 67. By suitable factory adjustment and design selection of the diameter(s) of aperture 63 and/or opening 67, the dampening function of the dashpot may be adapted to control how rapidly fluid can flow through those apertures during a down stroke of the piston 45, and then during the subsequent recovery upstroke of the piston 45.
The bellows chamber 52 and the dashpot chamber 70 that are fluidly connected by the fluid channels 63, 65 and 67 as discussed above, contain a mixture of compressible and non-compressible fluids so as to resist axial loads while providing some cushioning or yielding to those axial loads. It has been found that the functional life span of the device is substantially extended when the bellows chamber 52 is preloaded with fluid at a sub-atmospheric pressure. Preloading the bellows chamber 52 to a predetermined sub-atmospheric pressure is important and preferred for the present subject hydraulic spinal disc prosthesis assembly.
The method of preloading the collapsible, tiltable bellows assembly 1 is accomplished by first providing a collapsible, tiltable bellows assembly and then compressing the bellows 50 as much as possible—which is to say to the full stroke excursion-typically in the range of 0.05 to 0.06 inches. This compressed condition of bellows cartridge 100 is maintained by applying a constraining member (such as a clamp or the like) to the compressed bellows cartridge 100. Subsequently, the compressed bellows cartridge assembly 100 with the fluid channel 65 unplugged is placed into a vacuum chamber and the air is evacuated down to about 17-18 Torr at 20° C. at which point the compressed assembly 100 is fully immersed in the mixture of filling fluids. While immersed, the assembly 100 is exposed to sub-atmospheric pressure in the vacuum chamber so as to evacuate substantially all the air from the inside of bellows chamber 50, dashpot chamber 70 and the associated fluid conduits 63, 65, 67. Once this has been accomplished, the pressure in the vacuum chamber is adjusted to an atmosphere of pressure which causes the immersed bellows assembly 50 to fill with the fluid mixture. At this point the cartridge 100 with its compressed bellows assembly 50, now filled with the fluid mixture, is taken out of the vacuum chamber and fluid conduit 65 is sealed with the sealing member 60 such as a plug or screw or similar sort of elements.
Once the fluid conduit 65 is sealed, thereby closing the cartridge's bellows chamber 52 and dashpot chamber 70, the cartridge 100 is allowed to re-expand by removing any constraining member such as a clamp or the like, thereby permitting the biasing member(s) 80—such as the coil spring in proximity with the dashpot piston 45—to force apart the opposing end caps 39, 39′ and connected structures with approximately 250 to 325 pounds of compressed spring force, thereby re-expanding the bellows cartridge 100 to its uncompressed condition.
The biasing member 80 within the cartridge 100 exerts a distracting force, preferably in the range of 250 to 325 pounds, that tends to separate the crown plates 10, 10′. By uncompressing the bellows assembly 100 containing the fluid mixture that had been introduced at standard temperature and pressure, the bellows and dashpot chambers, 52 and 70 respectively, expand. With the bellows assembly 100 in the expanded condition, the fluid mixture occupies a proportionately larger volume thereby causing a concomitant lowering of pressure therein to sub-atmospheric levels: this accomplishes the pre-loading of the cartridge 100 by providing a sub-atmospheric fluid pressure within the fluid compartments of uncompressed disc prosthesis cartridge 100.
The insertion tool assembly 300 comprises a handle assembly 310 formed distally at one end, and at the opposite end, the proximal end, by a prosthesis engaging member 360; the handle assembly 310 further comprises an elongate tubular member 330 connecting the prosthesis engaging member 360 to handle grip member 340 and knob control mechanism 350. As illustrated in
The insertion tool handle 340 has at its proximal end a threaded knob that is axially rotatable. By rotating the threaded knob 350 a connecting rod 355 is displaced longitudinally either forward or backward according to the direction in which the threaded knob 350 is turned. By rotating the threaded knob 350 so as to thereby move connecting rod 355 proximally—which is to say toward the effector head 360—the proximal end of the connecting rod 355, formed with at least one cam member 356 at its proximal end, pushes against at least one hinged and spring-biased pawl-displacing lever arm members 370, 370′. As may be further appreciated by viewing
As seen in
The insertion tool 300 further comprises a pair of distraction bars 320 whose dimensions matingly complement the through channels 14 so that distraction bars 320 act as guide rails for the disc prosthesis assembly 1 to be slidingly advanced into position along the distraction bars 320 during the implantation procedure.
As shown in
By impeding the equilibrating flow of fluid from the dashpot chamber 70 to the bellows chamber 52, the dashpot offers greater resistance to the imposed axial load than if unimpeded equilibration of the fluid pressure were permitted. Other alternative embodiments may provide for more than one such bellows chamber openings 67, for example, to avoid asymmetries in the biomechanics that can change according to the direction of twisting and/or bending during axial load bearing. Keeping constant all the other fluid conduit specifications, the total cross-sectional area of the bellows chamber openings 67 is the primary determinant of the impeded fluid equilibration that augments the device's resistance to axial forces, rather than the actual number of such openings.
The embodiment depicted in
Surgical Procedure
The particular crown plates 10, 10′ and the particularly selected bellows cartridge assembly 100 to be implanted in a specific patient are chosen by the surgical team so as to best accommodate the anticipated biomechanical demands of that particular patient's spinal disc replacement. Once the disc prosthesis components have been selected, the crown plates 10, 10′ are connected to the bellows cartridge assembly 100 by aligning and advancing cartridge 100 along the chined edges 6, 7 of the crown plates 10, 10′ that complement the chined edges of the cartridge's end caps 20, 20′. This coupling is similar to dove-tail joinery used in cabinet making, for example, in a cabinet drawer. Once the assembly is accomplished for both opposing crown plates, the juxtaposition of the crown plates 10, 10′ with cartridge 100 is fixedly secured by advancing set screws 96 into the threaded through holes 95A, 95B until the set screws 96 occupy crown plate recesses 22A, 22B; 22′A, 22′B, at which point the set screws 96 cannot be advanced any further and the crown plates 10, 10′ are fixedly attached to the cartridge 100.
With the spinal disc prosthesis 1 thus assembled with selectable components chosen to optimize the biomechanics of the effected intervertebral space and joint, the prosthesis assembly 1 is attached to the insertion tool 300. This is done by sliding the insertion tool's distal head 360 between the crown plates 10 so that the beveled edges of the insertion tool's distal surface matingly complement the beveled inner edges of the crown plate 6, 7; with the insertion tool effector head 360 juxtaposed against the opposed crown plates 10, 10′ but not in contact with the bellows cartridge 100, threaded knob 350 is rotated so as to displace pawls 369 into the respective recesses 91 in the crown plates 10. When the pawls are seated in their respective recesses, the insertion instrument 300 is reversibly coupled with the spinal disc prosthesis assembly 1.
In the preferred embodiment, the diseased spinal disc is surgically approached from the patient's anterior and the diseased disc is removed by surgical techniques well known to those skilled in surgical arts. A standard vertebral distracting instrument is used to sufficiently spread apart the adjacent vertebrae so as to accommodate the spinal disc prosthesis assembly 1. This standard vertebral distracting instrument has paired, opposing, detachable, interchangeable end pieces and the vertebrae are typically separated using a pair of rounded paddle attachments attached to the distracting instrument so that whatever force is necessary is applied over the largest possible surface area, thereby minimizing the risk of causing a vertebral endplate fracture or other trauma.
The space between the vertebral endplates accomplished by distracting the vertebrae should be wide enough for the crown plates 10 to slide into but not so the spikes 12 can clear the endplates. The spikes 12,12′ protruding from the vertebral engaging surfaces of the crown plates 10, 10′ cuttingly engage the vertebral end plates during intra-operative positioning and placement of the prosthesis, thereby creating bony channels in the vertebral endplates, each channel extending from anterior to posterior.
Once the vertebrae are sufficiently distracted as described above, the distracting tool may be removed without fear of the vertebrae suddenly re-approximating; the vertebrae do not simply spring back into juxtaposition, vertebral re-approximation being a very slow process. At this point, the distracting paddles are detached and the upper and lower (cephalad and caudal) distraction bars 320 are fitted onto the standard distracting instrument. Each distracting bar 320. 320′ is positioned in the midline of the respective vertebral end plates within the intervertebral space. The proper positioning and alignment of the disc prosthesis 1 in the intervertebral space is crucial for the subsequent functioning of the spinal disc prosthesis 1. Proper surgical placement of the distraction bars 320, 320′ is confirmed by methods well known to the surgical arts, including but not limited to palpation, visual inspection, fluoroscopic and x-ray confirmation, and other stereotactic guiding measures well known to those skilled in the surgical arts.
The surfaces of the distraction bars 320, 320′ are roughened in the same or similar way as are the vertebral engaging surfaces of the crown plates 10, 10′ thereby allowing the distraction bars 320, 320′ to better maintain their preferred positioning as determined by the surgical team. With the distraction bars 320, 320′ in place and still connected to the standard distracting tool with its angled extension arm seen in
The advancement of the disc prosthesis assembly 1 into the intervertebral space requires some considerable force, as may be applied with a mallet or hammer or other such instrument. To avoid damaging the bellows cartridge assembly 100, the insertion tool 300 connectedly contacts the crown plates 10, 10′ without making any contact with the bellows cartridge 100; this is seen in the side view of the insertion tool 300 coupling with prosthesis 1 in
Once the spinal disc prosthesis assembly 1 is in the desired position, the insertion tool 300 is disconnected by reversing the connection of the pawls 310A,B and 310′A,B in the recesses 91A,B and 91′A,B respectively. Retraction of the pawls 310 from recesses 91, effected by rotation of the control handle knob 350, permits the insertion tool 300 to be withdrawn while leaving the prosthesis 1 in place. The distraction bars 320 are then slidingly withdrawn along channels 14 and out of the intervertebral space, thereby leaving the spinal disc prosthesis assembly 1 as the only hardware left in place between the opposing vertebrae. The rest of the implantation, involving the surgical wound closure and so forth, is well known to those skilled in the surgical arts.
Although this invention has been described in connection with specific forms and embodiments thereof, it should be appreciated that various modifications other than those discussed above may be resorted to without departing from the spirit or scope of the invention. For example, equivalent elements may be substituted for those specifically shown and described, certain features may be used independently of other features, and in certain cases, particular locations of elements may be reversed or interposed, all without departing from the spirit or scope of the invention as defined in the appended claims.
This application is a Continuation-in-Part of co-pending application Ser. No. 10/419,899 that was filed on 22 Apr. 2004.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10419899 | Apr 2003 | US |
| Child | 11110893 | Apr 2005 | US |
